Factors affecting disease control after pituitary tumor resection in acromegaly: What is the current evidence?

Abstract

Acromegaly, characterized by persistent hypersecretion of growth hormone (GH), is most often caused by a pituitary neuroendocrine tumor (PitNET), though, less often, ectopic GH or GH-releasing hormone secretion from various neoplasms outside the pituitary gland could cause it. Nearly 70% of somatotroph PitNETs are macroadenomas at diagnosis. Transsphenoidal surgery, the most effective treatment modality for acromegaly, could achieve remission in 73%. However, the remission rates could reach 87% if surgery is followed by medical therapy. Due to variable therapeutic responses to surgical and medical therapy, pre-treatment awareness regarding the best therapeutic modality based on clinical, biochemical, radiological, histopathological and genetic parameters would help in accurate pretreatment decision-making. Earlier studies have identified poor prognosis markers like tumor size, tumor invasion, T2-weighted hyperintensity, granulation, and pretreatment GH and/or insulin-like growth factor 1 levels. In a recent study, published by Alvarez et al identified that preoperative PitNET volume is a good predictor of control of acromegaly following surgical treatment and the likelihood of requiring more aggressive additional therapies after surgery. They found that PitNET volume exceeding 3697 mm³ was associated with poorer disease control in patients with somatotroph PitNETs.